“Serious Medical Need” in the Corrections Environment

EXECUTIVE SUMMARY: Under 42 U.S.C. § 1983 in the Sixth Circuit, there are several different scenarios in which a prisoner has a “serious medical need” for purposes of a deliberate indifference claim. These scenarios vary depend upon the type of serious medical need at issue, the nature of the treatment required or claimed to be required, and the eventual alleged resulting harm. This article explains the applicable 42 U.S.C. § 1983 legal standards defining “serious medical need” for a deliberate indifference claim, and provides advice for identifying potential serious medical needs and for minimizing 42 U.S.C. § 1983 claims of deliberate indifference.

I. There is an obvious urgent or emergent medical situation that does not require medical training to recognize1.

This is the type of serious medical need that would cause a layperson to call 911 or immediately drive someone to a hospital or urgent care clinic. Examples of this scenario are: someone is unconscious and unresponsive; someone is having classic heart attack symptoms; someone has an obvious broken bone; someone cannot breathe; or someone suddenly cannot walk.

Many times the defendants in lawsuits involving this kind of serious medical need are police officers or corrections officers. While it is rare that correctional health care professionals face this kind of 42 U.S.C. § 1983 litigation, it can happen. This is largely because of the unique challenges that medical personnel face in the corrections environment. They sometimes are faced with a situation in which a prisoner patient appears to be malingering or exaggerating. In those situations, it is crucial to rule out a true medical emergency and to document the situation thoroughly in the patient’s medical record.

II. A physician has diagnosed a medical condition and determined that it requires medical treatment1.

In this situation, it can be either a prison medical provider or a physician outside the prison system who diagnoses the patient with the serious medical need. The 42 U.S.C. § 1983 problem arises when the patient does not get the treatment he or she needs or does not get it in a timely manner. This can happen due to electronic medical record failures, issues with scheduling, issues with prescriptions, general delays, etc. Even the most diligent of medical professionals cannot always prevent these 42 U.S.C. § 1983 claims of deliberate indifference. When there is a problem, usually someone identifies it and addresses it before adverse consequences occur—but not always. Medical providers are wise to do all that they can to ensure and confirm the implementation of their treatment plans to avoid 42 U.S.C. § 1983 litigation claiming that they showed deliberate indifference to a prisoner’s serious medical need.

A. Differences in Medical Opinion

Sometimes there is a difference in medical opinion regarding the correct diagnosis or correct treatment plan, and providers disagree about whether a particular serious medical need exists. Some examples of this are: a prison medical provider does not agree with the discharge instructions from a hospital based upon a lack of medical evidence to support them; or a prison medical provider requests specialty care but the utilization management physician does not agree that the specialty care is medically necessary. In those situations, the provider must enter thorough documentation into the medical record to show what medical decisions have been made and why with respect to the alleged serious medical need.

If a request for specialty care is not approved, the provider should appeal the decision unless he or she understands and accepts the basis for the decision. An appeal ensures that the potential serious medical need gets further consideration and ensures that the provider can explain why the treatment he or she recommended was not given in the event of a 42 U.S.C. § 1983 lawsuit. While a difference in medical opinion cannot serve as the basis for a deliberate indifference claim, a plaintiff can argue that a particular medical opinion was not reasonable. Youngberg v. Romeo, 457 U.S. 307, 321 (1982); Westlake v. Lucas, 537 F.2d 857, 860 n.5 (6th Cir. 1976). When that happens, retained experts become essential to the defense of the 42 U.S.C. § 1983 litigation.

B. Alleged Delays in Treatment

Frequently plaintiffs in 42 U.S.C. § 1983 lawsuits allege that there has been an improper delay in treatment of their serious medical needs. Examples of these claims are disputes over whether and when a prisoner needed to have orthopedic surgery, disputes over whether it took too long to diagnose and treat a prisoner’s disease, etc. It is important to note, however, that delay alone is insufficient to establish deliberate indifference under 42 U.S.C. § 1983. Napier v. Madison County, Ky., 238 F.3d 739, 742-743 (6th Cir. 2001). The only actionable delay is a delay that is actually detrimental to the patient. Napier v. Madison County, Ky., at 742-743. To support this type of deliberate indifference claim, a plaintiff must have medical evidence confirming that the delay was harmful. Id. That is often difficult and generally requires that the plaintiff have supporting expert testimony. Still, the best practice is to avoid delay in treatment of a potentially serious medical need whenever possible to minimize 42 U.S.C. § 1983 litigation.

C. Claims Regarding Adequacy of Treatment

Prisoners also frequently claim that the care that they received for a serious medical need was inadequate. To constitute deliberate indifference under 42 U.S.C. § 1983, the medical care in question must have been grossly inadequate, meaning that no reasonable doctor would conclude that the treatment was lawful. Terrance v. Northville Reg’l Psychiatric Hosp., 286 F.3d 834, 843-844 (6th Cir. 2002). An often cited and particularly gruesome example of grossly inadequate care constituting deliberate indifference to a serious medical need under 42 U.S.C. § 1983 is Williams v. Vincent, a case in which a doctor told a prisoner patient that he did not need his ear and threw away the severed ear in the patient’s presence. Williams v. Vincent, 508 F.2d 541, 544 (2d Cir. 1974)

D. Conclusion

Being savvy about the different scenarios in which a serious medical need can arise in the corrections environment can help medical personnel improve their ability to identify these needs quickly and prevent legal problems in the future. Even when 42 U.S.C. § 1983 litigation happens, many deliberate indifference cases are highly defensible. In any case, skilled defense attorneys can narrow the claims and issues at stake, present your decisions in the best light, and develop an overall defense strategy to attain the best outcome possible.

If you are facing a deliberate indifference lawsuit, would like to learn more about what constitutes a “serious medical need” or other aspects of a 42 U.S.C. § 1983 claim, or have questions regarding any aspect of correctional health care, contact the 42 U.S.C. § 1983 experts at Chapman Law Group today.